Presentation
Fell off a motorbike 2 weeks ago. Severe pain and unable to abduct the arm
Patient Data
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The major abnormality is a gross musculotendinous tear of infraspinatus. It is almost complete. Considerable fluid within the defect and surrounding soft tissue swelling.
The supraspinatus tendon is also abnormal. It is swollen and contains a full thickness tear posteriorly. Anteriorly the tendon remains intact.
There is moderate AC arthropathy with upward displacement of the clavicular head in relation to the acromion. Coraco-clavicular ligament seems intact albeit elongated presumably due to an old injury with AC subluxation.
Case Discussion
This is an unusual but recognized complication of trauma that can be missed on routine shoulder ultrasound due to its posteromedial location. It may require surgical repair and if not diagnosed may go on to gross muscle atrophy with complete loss of function.